title: Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism.
abstract: BACKGROUND
  Presenting signs and symptoms of pulmonary embolism (PE) are nonspecific, favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography (MCTPA), thus exposing patients to high-dose radiation and to potential serious complications. We investigated the diagnostic performance of multiorgan ultrasonography (lung, heart, and leg vein ultrasonography) and whether multiorgan ultrasonography combined to Wells score and D-dimer could safely reduce MCTPA tests.
  
  
  METHODS
  Consecutive adult patients suspected of PE and with a Wells score &gt; 4 or a positive D-dimer result were prospectively enrolled in three EDs. Final diagnosis was obtained with MCTPA. Multiorgan ultrasonography was performed before MCTPA and considered diagnostic for PE if one or more subpleural infarcts, right ventricular dilatation, or DVT was detected. If multiorgan ultrasonography was negative for PE, an alternative ultrasonography diagnosis was sought. Accuracies of each single-organ and multiorgan ultrasonography were calculated.
  
  
  RESULTS
  PE was diagnosed in 110 of 357 enrolled patients (30.8%). Multiorgan ultrasonography yielded a sensitivity of 90% and a specificity of 86.2%, lung ultrasonography 60.9% and 95.9%, heart ultrasonography 32.7% and 90.9%, and vein ultrasonography 52.7% and 97.6%, respectively. Among the 132 patients (37%) with multiorgan ultrasonography negative for PE plus an alternative ultrasonographic diagnosis or plus a negative D-dimer result, no patients received PE as a final diagnosis.
  
  
  CONCLUSIONS
  Multiorgan ultrasonography is more sensitive than single-organ ultrasonography, increases the accuracy of clinical pretest probability estimation in patients with suspected PE, and may safely reduce the MCTPA burden.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01635257; URL: www.clinicaltrials.gov.
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze. Electronic address: pnazerian@hotmail.com.
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.affiliation: Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Volpicelli
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gigli
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.affiliation: Radiology Department, Careggi University Hospital, Firenze.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bartolucci
authors.affiliation: Department of Emergency Medicine, Pierantoni Morgagni Hospital, Forlì.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciavattone
authors.affiliation: Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lamorte
authors.affiliation: Radiology Department, San Luigi Gonzaga University Hospital, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
authors.affiliation: Department of Emergency Medicine, Pierantoni Morgagni Hospital, Forlì.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fabbri
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult